| NPI | 1598090953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: FL RBT-24-364433) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA#56213) |
| Enumeration Date | 2009-10-02 |
| Last Update Date | 2024-11-08 |